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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
Curriculum
VPH yCáncer CervicalUICC
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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01 Capítulo 2.e.
Detección y Diagnóstico – Estadío
Prof. Achim Schneider, MD, MPHCharité Universitätsmedizin Berlin, Germany
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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02 Cáncer del cuello uterino• Diagnóstico
• Estadío
• Terapia
- Cirugía
- Radiación
- Tratamiento sistémico
• Pronóstico
• Seguimiento
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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03 Sistema de Estadificación FIGO
Estadío I Estadío II
Estadío III Estadío IV
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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04 Estadío I (1)
TNM
FIGO
TX Tumor primario no se puede determinar
T0 No hay evidencia de tumor primario
Tis 0 Carcinoma in situ (cancer pre invasivo)
T1 I Carcinoma de cérvix limitado al útero (extensión al cuerpo del útero debe obviarse)
T1a I A Cáncer invasivo solo diagnosticado con examen microscópico . Todas las lesiones visibles macroscópicamente (incluyendo las lesiones superficiales) son estadío IB/T1b
T1a1 I A1 Invasión del estroma de no más de 3 mm de profundidad y no más de 7 mm de ancho
T1a2 I A2 Invasión del estroma mayor de 3mm pero no mayor de 5 mm en profundidad y no más de 7 mm de ancho
T1b I B Lesión clínicamente visible confinada al cérvix o una lesión microscópica mayor de IA2
T=Tumor primario; N=Ganglios linfáticos regionales; M=Metástasis distantes FIGO: Federación Internacional de Ginecología y ObstetriciaReferencia: http://screening.iarc.fr/atlasclassiftnm.php#reference
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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05 Estadío I (2)
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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06 Estadío I (3)
TNM
FIGO
T1b I B Lesión clínicamente visible confinada al cérvix o lesión microscópica mayor de IA2
T1b1 I B1 Lesión clínicamente visible de 4 cm o menos en tamaño
T1b2 I B2 Lesión clínicamente visible de mas de 4 cm en tamaño
T=Tumor primario; N=Ganglios linfáticos regionales; M=Metástasis distantes FIGO: Federación Internacional de Ginecología y ObstetriciaReferencia: http://screening.iarc.fr/atlasclassiftnm.php#reference
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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07 Estadío I (4)
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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08 Estadío II
TNM
FIGO
T2 II Tumor invade más allá del útero pero no la pared pélvica o el tercio inferior de la vagina
T2a II A Sin invasión del parametrio
T2b II B Con invasión del parametrio
T=Tumor primario; N=Ganglios linfáticos regionales; M=Metástasis distantes FIGO: Federación Internacional de Ginecología y Obstetricia Referencia: http://screening.iarc.fr/atlasclassiftnm.php#reference
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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09 Estadío III
TNM
FIGO
T3 III Tumor se extiende a la pared pélvica o el tercio inferior de la vagina , o ambos o causa hidronefrosis o perdida de función renal
T3a III A No hay extensión a la pared pélvicaTumor envuelve el tercio inferior de la vagina
T3b III B Tumor se extiende a la pared pélvica o causa hidronefrosis o perdida de función renal
T=Tumor primario; N=Ganglios linfáticos regionales; M=Metástasis distantes FIGO: Federación Internacional de Ginecología y ObstetriciaReferencia: http://screening.iarc.fr/atlasclassiftnm.php#reference
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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10 Estadío IV
TNM
FIGO
T4 IV Tumor infiltra la mucosa de la vejiga urinaria o recto, o se sale de la pelvis, metástasis distantes
T4 IV A Tumor invade la mucosa de la vejiga urinaria y recto, o se sale de la pelvis
T4 IV B Metástasis distantes
T=Tumor primario; N=Ganglios linfáticos regionales; M=Metástasis distantes FIGO: Federación Internacional de Ginecología y ObstetriciaReferencia: http://screening.iarc.fr/atlasclassiftnm.php#reference
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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11 Estadío - problemas
• Cáncer de cérvix es el único tumor ginecológico en el cual solo se utiliza información clínica para determinar el estadío!
- Solo se considera la palpación, cistoscopía, rectoscopía, biopsia o conización e imágenes de rayos X (urograma intravenoso, radiografía de tórax)
- Información obtenida con tomografía computarizada, cintigrafía, linfografía, resonancia magnética, o laparoscopía no se consideran para asignar el estadío
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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12 Sistema de estadificación FIGO
• FIGO no considera:
- El estatus de los ganglios linfáticos
- Invasión de la vejiga urinaria o recto
- Diseminación intra-abdominal
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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13 Imágenes
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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14 Infiltración de la Vejiga
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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15 Infiltración de los pilares rectales
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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16 Infiltración del saco de Douglas
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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17 Evaluación de los ganglios linfáticos para-aórticos
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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18 Ganglios linfáticos pélvicos izquierdos positivos
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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19 Resección de un tumor que infiltra los ganglios linfáticos para-aórticos
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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20 Ganglio linfático centinela en cáncer de cérvix – marcador azul
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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21Ganglio linfático centinela en cáncer de cérvix – marcado con tecnecio e identificado con instrumento que detecta rayos gamma
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UICC HPV and Cervical Cancer Curriculum Chapter 2.e. Screening and diagnosis - StagingProf. Achim Schneider, MD, MPH
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22
Gracias
Esta presentación está disponible en www.uicc.org/curriculum